This Month in Archives of Dermatology

Trends in Pediatric Psoriasis Outpatient Health Care Delivery in the United States

Most pediatric patients with psoriasis present with mild, localized disease that is primarily treated with topical medications. Management of pediatric psoriasis can be challenging owing to a lack of data and standardized treatment guidelines. In this retrospective, cross-sectional investigation, Vogel et al confirm that pediatric psoriasis visits are frequent and that dermatologists and pediatricians are the primary physicians consulted. Treatment techniques differed by patient age and physician specialty, and although the data may be biased toward milder disease, the results suggest that pediatric patients may be undertreated.

Chronic urticaria is a common and frustrating disorder. More than 50% of patients continue to experience chronic urticaria 10 years after initial diagnosis. Only limited epidemiologic information is available about the exact extent of the association between chronic urticaria and cancer. In this retrospective population-based cohort study, Chen et al demonstrate that patients with chronic urticaria were at increased risk of cancer, particularly hematologic malignancies. Most cancer cases were detected within the first year of urticaria diagnosis.

High Frequency of Genital Lichen Sclerosus in a Prospective Series of 76 Patients With Morphea

Morphea and lichen sclerosus (LS) are each characterized by plaques of indurated, sclerotic, and dyschromic skin and by an inflammatory dermal infiltrate and fibrosis. Despite the similarities between the 2 entities, their exact relationship remains unclear. In this prospective multicenter study, Lutz et al demonstrate that genital LS is significantly more common in patients with morphea. Early diagnosis and treatment of genital LS with topical corticosteroids can reduce the risk of squamous cell carcinoma. These data indicate that careful examination of genital mucosa should be performed in patients with morphea to allow for early diagnosis and treatment of LS.

Comparable Effectiveness of Endovenous Laser Ablation and High Ligation With Stripping of the Great Saphenous Vein

Chronic venous insufficiency caused by varicose veins has prevalence rates as high as 28% to 35% among adults. Treatments aim to eliminate pathologic refluxes, and high ligation and saphenous vein stripping remains the standard therapy despite recurrence rates of 30% to 40% at 5 years. Particularly at the saphenofemoral junction, recurrence is often caused by neovascularization, which might be treated with minimally invasive endovenous laser treatment (EVLT). In this randomized controlled trial, Rass et al demonstrate that both methods were equally effective and safe approaches to treating great saphenous vein incompetence, with minor advantages for EVLT with respect to cosmetic outcome and recovery.

Newly approved medical therapies and laser therapies have influenced the practice patterns for the management of plaque-type psoriasis in the United States. Newly updated consensus guidelines are presented here to reflect these new agents and technologies. Management of psoriasis in special populations is discussed, including sections on children, pregnant patients, nursing mothers, elderly patients, patients with hepatitis B or C virus infections, patients with human immunodeficiency virus, and patients with malignant neoplasms. Tumor necrosis factor blockers, elective surgery, and vaccinations are also addressed.